Acute Tonsillitis - Etiology, Types, Clinical Features, Investigations, Treatment & Complications
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🦠 Acute Tonsillitis
Acute tonsillitis is the acute inflammation of the palatine tonsils, which may involve the:
- Mucosa
- Crypts of the tonsil
- Follicles
- Tonsillar parenchyma
The type of acute tonsillitis depends on which part of the tonsil is involved.
What are the parts of the palatine tonsil?
Age Group Affected
- Most common in school-going children
- Followed by young adults
⭐ Rare in infants and in adults over 50 years of age.
Etiology of Acute Tonsillitis
Acute tonsillitis may occur as:
1- A localized episode
2- In association with an upper respiratory tract illness
3- Part of a generalized systemic infection
What is the most common causative organism in Acute tonsillitis?
What microorganisms are involved in causing Acute tonsillitis?
What is the Route of Spread in Acute tonsillitis?
Pathophysiology of Acute Tonsillitis
Inflammation begins within the tonsil
→ Hyperemia and edema
→ Lymphoid follicles of the tonsil convert into small abscesses
→ Abscesses discharge into the crypts of the tonsil
⭐ The palatine tonsil forms a part of Waldeyer's ring, the protective lymphoid structure of the upper aerodigestive tract responsible for immunity.
What are the structures forming the Waldeyer's ring?
What is the clinical significance of Waldeyer's ring?
Types of Acute Tonsillitis
Based on the progression of the disease:
1- Acute Catarrhal (Superficial) Tonsillitis
- Tonsils are inflamed as a result of a generalized infection of the oropharyngeal mucosa
- Commonly seen along with acute pharyngitis
- Usually occurs due to a viral upper respiratory tract infection
2- Acute Follicular Tonsillitis
- Inflammatory exudate collects in the tonsillar crypts
- Exudate presents on the surface of the tonsil as multiple yellowish white spots
- The spots correspond to the openings of the crypts
3- Acute Membranous Tonsillitis
⭐ One stage ahead of follicular tonsillitis.
- Untreated follicular tonsillitis progresses to this stage
- The yellowish white spots and exudate from the crypts coalesce to form a membrane over the surface of the tonsil
What is the differential diagnosis of membrane over the tonsil?
4- Acute Parenchymatous Tonsillitis
- The whole tonsillar parenchyma becomes uniformly congested and swollen
- Occurs due to hyperplasia of the lymphoid follicles in the tonsillar parenchyma
- Tonsils appear uniformly enlarged on both sides, reddish and congested
Clinical Features of Acute Tonsillitis
Symptoms of Acute Tonsillitis
- Sore throat
- Dysphagia
- Fever
- Earache
- Constitutional symptoms
- Voice change
What is the most common symptom seen in Acute tonsillitis?
What are the causes of earache in Acute tonsillitis?
What is the reason behind voice change in Acute tonsillitis?
Signs of Acute Tonsillitis
General Examination
- Toxic look (especially in children)
- Fever
Oral Cavity & Oropharynx
- Coated tongue
- Halitosis
- Hyperemia of the tonsillar pillars, soft palate and uvula
What is the reason behind coated tongue and halitosis in Acute tonsillitis?
Findings According to Type of Tonsillitis
| Type | Findings |
|---|---|
| Acute Catarrhal Tonsillitis | Generalized congestion involving the posterior pharyngeal wall |
| Acute Follicular Tonsillitis | Reddish, swollen tonsils with yellowish white spots of purulent material at the crypt openings |
| Acute Membranous Tonsillitis | Whitish membrane over the medial surface of the tonsil, easily wiped away with a swab |
| Acute Parenchymatous Tonsillitis | Enlarged, congested tonsils almost meeting in the midline, with edema of the uvula and soft palate |
Neck Examination
- Enlarged and tender jugulodigastric nodes
⭐ Jugulodigastric nodes are the primary nodes draining the tonsils.
Investigations of Acute Tonsillitis
Acute tonsillitis is primarily a Clinical diagnosis.
Investigations are mostly done in patients not responding to treatment.
1- Complete Blood Count
- Leukocytosis with neutrophilia (acute infection)
- Lymphocytosis is seen in chronic infection
2- Rapid Strep Test
3- Throat Swab for Culture & Sensitivity
Where is the throat swab taken from in a suspected case of Acute tonsillitis?
4- ASO Titre
Elevated Anti-Streptolysin O antigen indicates streptococcal infection
5- Peripheral Smear
To rule out:
- Agranulocytosis
- Leukemia
6- Monospot Test
To rule out Infectious mononucleosis
Treatment of Acute Tonsillitis
1- Supportive Treatment
- Bed rest
- Plenty of fluids
2- Analgesics & Antipyretics
- Paracetamol
- Aspirin
3- Antibiotics
| Situation | Drug |
|---|---|
| Streptococcal infection | Penicillin (Drug of choice) |
| Beta-lactamase producing organisms | Amoxicillin + Clavulanic acid |
| Penicillin allergy | Erythromycin |
- Antibiotics are continued for 7–10 days
- IV antibiotics are started in severe infection or a toxic, ill patient
4- Antiseptic Throat Gargles
- Betadine gargles
- Lukewarm saline gargles
Complications of Acute Tonsillitis
- Chronic Tonsillitis
- Abscess Formation
- Acute Otitis Media
- Streptococcal Complications
- Rheumatic fever
- Acute glomerulonephritis (rarer nowadays)
- Subacute bacterial endocarditis
- Septicemia
- Internal Jugular Vein Thrombosis
What are the Paradise Criteria for tonsillectomy?
What are the different abscesses that can form as complication of Acute tonsillitis?
How does Acute otitis media form in a case of Acute tonsillitis?
What is the microorganism involved in Subacute bacterial endocarditis?
Differential Diagnosis of Acute Tonsillitis
- Scarlet fever
- Diphtheria
- Vincent's angina
- Infectious mononucleosis
- Agranulocytosis
- Glandular fever
- Leukemia
⭐ In diphtheria, a true membrane is seen over the tonsil, whereas acute membranous tonsillitis shows a false membrane (pseudomembrane).
What is a true membrane and a false membrane? How will you differentiate it clinically? What are the causes of true membrane and false membrane over tonsil?
🧠 Viva Pearls
- Acute tonsillitis is acute inflammation of the palatine tonsils.
- Most common in school-going children, followed by young adults.
- Rare in infants and adults over 50 years of age.
- Palatine tonsil is a part of Waldeyer's ring.
- Acute catarrhal tonsillitis is usually due to a viral upper respiratory tract infection.
- Acute follicular tonsillitis shows yellowish white spots at the crypt openings.
- Acute membranous tonsillitis is one stage ahead of follicular tonsillitis.
- Acute parenchymatous tonsillitis occurs due to hyperplasia of the lymphoid follicles.
- Jugulodigastric nodes are the primary nodes draining the tonsils.
- Rapid strep test is highly specific but less sensitive than culture.
- Penicillin is the drug of choice; erythromycin is used in penicillin allergy.
- Antibiotics are continued for 7–10 days.
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